Provider Demographics
NPI:1821477381
Name:MOHR ADULT PSYCHOLOGICAL SERVICES CORP
Entity Type:Organization
Organization Name:MOHR ADULT PSYCHOLOGICAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:848-391-5531
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-0794
Mailing Address - Country:US
Mailing Address - Phone:848-391-5531
Mailing Address - Fax:
Practice Address - Street 1:1615 PARK AVE
Practice Address - Street 2:APT 6G
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-5281
Practice Address - Country:US
Practice Address - Phone:848-391-5531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047935001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1265512479OtherNPI INDIVIDUAL
NJ1881881498OtherMEDICARE NPI 1881881498 (GROUP)
NJ073095OtherPTAN GROUP
NJ1265512479OtherNPI INDIVIDUAL